严重胸廓畸形食管贲门癌手术死亡原因分析(附6例报告)  

A research on the analisis and treatment of cardial carcinoma of esophagus with severe chest deformity(attached with a report on six cases)

作　　者：李胡屯 宋文斌[2] 郭志华 王光军 张敬强 

机构地区：[1]晋城市人民医院,山西晋城048000 [2]长治医学院附属医院,山西长治046000

出　　处：《山西临床医药》2000年第10期763-765,共3页Shanxi Clinical Medicine

摘　　要：报告严重胸廓畸形食管贲门癌手术死亡 4例 ,其主要原因是漏斗胸、脊柱严重侧凸致胸廓畸形、内脏呈代偿性存在不同移位、主要呼吸肌发育不全、平素心肺功能储备低下 ,呈现运动耐量减退 ,加之手术使膈肌、肋间肌等遭到破坏 ,另有胸部占位、感染等综合因素 ,其手术死亡率甚高。从 1976年 11月～ 1989年 9月共行此类手术 4例均死亡 ,死亡原因均为术后呼吸衰竭。自 1989年 9月以来 ,对此类患者围手术期采取了改进措施 ,行同类手术 2例均顺利痊愈出院。改进措施主要是根据具体情况选择理想方式 ,即围绕对畸形胸廓的完整性不被破坏或尽可能使其损伤减少到最低限度 ,术后早期应用呼吸机支持 ,以偿还氧债。It is reported that the operations on 4 cases of cardial carcinoam of esophagus with severe thoracocyllosis have all ended in despire.Of the main reasons for the failure of the operations,funnelbreast,monstrous thoraces that result from severe scoliosis and splanchnodiastasis with compensatory reaction to some extent should be responsible excessively,what is more,the main respiratory muscles,such as diaphragm muscles,intercostal muscles,abdomen muscles,etc.Remain in the state of agenesia,the cardiopulmonary function is insufficient at usual time,the motor tolerance shows the tendency to decrease clinically.Furthermore,the diaphragm muscles,intercostal muscles have been destroyed during operation.All these,including such general factors as occupation,infection in thoracic cavity,lead to an extremely high death rate after operation.As a matter of fact,four cases of this sort,from November,1976 to September 1989,were treated by operation,but all died afterwards,and respiratory failure accounts for all the death.Since september 1989 improved measures have been taken during the operation.It turned out that two have fully recovered and have been discharged from hospital soon.The doctors succeeded in chosing proper treating methods in accordance with the patients’ special situation,that is,in order to make the monstrous thoraces intact,or be destroyed as slightly as possible,the patients must be helped by respirator after operation,whether bypoxia or not,to compensate oxygen as soon as possible.

关 键 词：胸廓畸形 食管贲门癌 死因 外科手术 

分 类 号：R655.106[医药卫生—外科学] R735.05[医药卫生—临床医学]